Child feeding habits in the People's Democratic Republic of Yemen. I. Breast and bottle feeding.
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Biomedical subjects
Publications and source records attributed to B Kristiansson.
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A study was undertaken to investigate growth in children with different types of early feeding problems without any obvious medical explanation. Altogether 42 children were studied and followed up to the age of two years. Twenty-five children refused to eat (RTE), nine had colic, seven had vomiting and one child displayed hyperirritability at mealtimes. Comparisons were made with controls matched for sex, age and residential area. Attained weight and length were measured frequently; rates of gain were calculated and the growth variables were transformed to standard deviation scores (SD scores). After the onset of the symptoms the SD scores of attained weight and length decreased significantly in the children with RTE and in those with vomiting (p less than 0.05), and the rate of weight gain was significantly lower in the RTE group than in the control group (p less than 0.001). At two years of age the children with vomiting had recovered and showed a complete catch-up growth, while the RTE group had attained significantly lower SD scores of attained weight (p less than 0.001) and length (p less than 0.001) than the control group. It was found that the risk of growth impairment was greatest in children who refused all food or all food except breast milk.
In order to investigate effects of khat chewing on uteroplacental blood flow (+)norpseudoephedrine (NPE) infusions were given to 11 anesthetized guinea pigs in late pregnancy (62-66 days) after unilateral uterine artery ligation at days 30-32. Regional blood flows were determined with radioactive microspheres. Mean arterial blood pressure increased with 25% and heart rate with 9% during NPE infusion. Myoendometrial blood flow was reduced by 31%. Placental vascular resistance (PVR) increased by 56% in the control horn (17 fetuses) and by 82% in the ligated horn (17 fetuses). This vasoconstriction was counteracted by the systemic vasopressor response since placental blood flow remained unchanged. When considering only the 13 growth-retarded fetuses, however, PVR increased by 98% and a 19% reduction of placental blood flow could be demonstrated. These results suggest that the placenta of the growth-retarded fetus may be more sensitive to adrenergic stimulation than the normal placenta. Furthermore, since one of the active constituents of khat, (+)norpseudoephedrine, causes vasoconstriction in the uteroplacental vascular bed it is possible that khat chewing could reduce placental blood flow and, as a consequence, impair fetal growth.
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An ethylenediamine-air mixture was generated in a dynamic gas mixing apparatus, and three different sampling techniques were tested. The analysis was performed using isotachophoresis. Sampling in an impinger flask containing hydrochloric acid (20 mmol/l) gave a quantitative recovery. Desorption losses were noticed when silica gel adsorption tubes were used. Cellulose filter support pads impregnated with oxalic acid were laborious to prepare, and the recovery was high only when freshly prepared filters were used. The use of impingers was found to be the most satisfactory method, and it was used for air monitoring in two factories handling ethylenediamine.
To evaluate the clinical significance of low rate of weight gain 81 infants wer investigated with a deviation of weight corresponding to a decrease of at least one S.D.-score of weight attained in the current Swedish growth chart. In 28 patients this decrease was of organic origin, notably intestinal disease. Three different growth variables were compared: attained weight (transformed to S.D.-score), change in S.D.-score of attained weight per time unit (= rate of change of deviation in S.D.-score/year) and rate of weight gain in kg/year (transformed to S.D.-score). Twenty-two of 28 infants with organic diseases had a subnormal rate of weight gain whereas only 12 attained subnormal weight for age. The use of rate of weight gain is the most sensitive growth variable and is far better than the use of attained weight as an indicator of ill-health. Change in S.D.-score of attained weight for screening purposes give good agreement with rate of weight gain, provided that age is taken into account.
Eighty-one infants were investigated to evaluate the clinical significance of low rate of weight gain. An organic etiology was found in 28 infants. The remaining infants were analysed with special respect to their psychosocial environment. Growth was assessed by rate of weight gain. Thirty-four infants had subnormal rates. Comparisons were made with 18 infants with low but normal rates and a control group of 72 infants. Several psychosocial risk factors were overrepresented in infants with subnormal rate of weight gain such as unemployment, ill-health in fathers, dependence on social welfare etc. No significant differences were found in perinatal factors except for birth weight. The magnitude of the load of adverse factors within the family was measured as a score. A significant negative correlation was found between the score obtained and the rate of weight gain.
Eighty-one children aged 4-18 months with unsatisfactory weight gain were investigated for organic diseases; the investigation included small-intestinal biopsy. Sixteen had total villous atrophy, in most cases due to gluten intolerance. Transient disease, e.g. cow's milk protein intolerance, was probable in 7 children with subtotal atrophy. In 18 children the only abnormal finding was an increased number of inflammatory cells in the mucosa, a finding which was probably of no clinical significance. Planimetric measurement showed good agreement between the mucosal surface/volume ratio and an ordinary histological grouping of the mucosa. A significant correlation was found between the rate of weight gain during the period preceding investigation and mucosal surface/volume ratio.
The present work investigated ill-health in 52 families of infants admitted to hospital with low rate of weight gain. Ill-health is measured as annual days of sickness cash entitlement, which is registered for all citizens within the state compulsory insurance scheme, with no waiting period. In the 34 families with infants having a weight gain outside the -2 S.D. limit there was a clear overrepresentation of fathers with high annual number of days of sick leave. The chief reasons for sick leave were skeletomuscular diagnoses. Comparisons are made with 18 families with infants having low rate of weight gain but within the -2.S.D. limit and 72 control families. Mothers of infants with subnormal increments tend to have more health problems than the other groups, but the differences are small. This can be explained by the use of the parent's cash benefit which covered the mothers during 210 days of the observed period, and by the differences in income between mothers and fathers. It is concluded that ill-health is overrepresented in families with infants presenting subnormal weight gain.
Nor-pseudoephedrine, one of the active ingredients of khat (Catha edulis), was found to be excreted in breast-milk in several lactating women who were chewing the leaves of the shrub according to the local customs. The compound could be traced in the urine of one breast-fed infant. It is concluded that the use of khat during lactation should be discouraged until further research has clearly elucidated the potential health hazards.
Khat chewing is a widespread male social habit in countries around the southern shore of the Red Sea and in eastern Africa and is also practiced by women, even during pregnancy and lactation. In order to study the potentially adverse effects of khat chewing during pregnancy, guinea pigs were fed 2.2 g/kg of khat leaves daily throughout the third trimester. Control animals were given aspen leaves. Maternal daily food intake was significantly reduced during the first 10 days of feeding and maternal weight gain was slightly lower in the khat group. Khat feeding of the mother significantly reduced the mean birth weight of the offspring by 7% without any effect on litter size or length of gestational period. Since low birth weight is a well-established risk factor for both perinatal and young infant death, khat chewing during pregnancy may be one of the factors contributing to infant mortality.
In order to investigate effects of khat chewing on uteroplacental blood flow, eight awake, chronically catheterized guinea pigs were fed 2.2 g khat leaves/kg in late pregnancy and regional blood flows were measured with the microsphere technique. Seven animals fed with aspen leaves in the same amounts served as controls. The mean concentration of (+)-norpseudoephedrine in urine 3 h after the end of the feeding was 4.6 micrograms/ml in the khat-fed group with no detectable amounts in the controls. Placental blood flow was reduced by 10% 75 min and by 24% 180 min after khat feeding. Since the khat dose used gave urinary concentrations of (+)-norpseudoephedrine of the same magnitude as those reported in khat chewing women, khat chewing in pregnancy may reduce placental blood flow and impair fetal growth.